Dodging Toilet Common Antic For Children

January 28, 1992|By MARY JO KOCHAKIAN; Family Affairs Columnist

They wiggle. They squirm. They jump up and down. And they say no, they don't have to go to the bathroom -- when obviously they do. To an adult, it's simple: When you really have to go, you stop what you're doing and get on with it. For children, it's not that easy. Instead of heading to the bathroom, they put their energies into stopping the urge.

They have their reasons, however unclear they may be to adults.

When a child has a persistent pattern of avoiding the bathroom, there are two aspects to consider -- the physical and the psychological, doctors say. Often it's not easy to separate the two.

In terms of the psyche, the reasons range "from the relatively benign issue of not wanting to leave a favored pastime to fairly severe problems of thinking, of mood, and relationships with authority figures," says Dr. William Sonis, director of research and administration at the Philadelphia Child Guidance Clinic of the University of Pennsylvania.

As for physiology, a problem such as a painful bout of constipation can lead the child to suppress the urge to eliminate, which starts a cycle.

For some children, it's pretty straightforward -- going to the bathroom is a lot less interesting than what they're doing at the moment. "There really are children who are `too busy playing' to want to take time," says Richard H. Granger, professor of pediatrics at the Yale Child Study Center in New Haven.

For others, "the kids for whom toileting has been a control battle all along," Granger says, putting off going to the bathroom is a way to challenge their parents' control.

These are typically children who were forced out of diapers too early, or have troubled relationships with their parents.

In most cases, the avoidance involves a physical problem, says Dr. M. Alex Geertsma, director of the early childhood development program at Hartford Hospital. For example, many preschoolers have tentative toileting skills, and some "are not really sold on the idea of going to the toilet." If the child becomes painfully constipated from a change in routine or diet, he or she may then withhold bowel movements. If the pattern continues, the colon becomes distended and the child "literally stops becoming aware" of

the urge to eliminate, Geertsma says. The problem is seen in older children, too. "Often many have the same underlying physical conditions [as] younger children," Geertsma says, and "lack of developmental readiness about orderly toileting." Some are by nature preoccupied and disinclined to think ahead.

Sometimes problems start when children avoid school restrooms because they lack privacy, Geertsma says. So they wait.

While such physical causes are common, "one pattern shouldn't be underplayed," Geertsma says: An older child without a history of physical problems in elimination who begins to suppress the urge to go may have an emotional problem.

Parents need professional help with a child's longstanding avoidance of using the toilet. There are wide variances in development as well as individual circumstances. "That's where you have to talk with your physician or behavioral specialist," Geertsma says.

Granger says parents should insist on a detailed discussion. But for those little children who are putting off bathroom visits largely because of the inconvenience, parents can help.

"You say, `Look, sometimes you really do need to go and you don't want to take the time, but it's much easier for all of us, including you, if you'll do it. Then we can get on with the work and play in a much better way.' And then repeat that message without getting angry," Granger says.

Sonis says if a child "has difficulty paying attention to the stimuli of their body that says, `Go pee,' then it's important parents try to train them to be attentive."

Other options include giving lots of fluids, and gradually increasing the time between visits to the bathroom. Have the child make regular trips to the bathroom, giving the child a reward for using the toilet"so they begin to associate a full bladder with positive consequences."